Scope of Occupational and Environmental Health Programs and Practice

3/3/2011 Scope of Occupational and Environmental Health Programs and Practice The scope of practice of occupational and environmental medicine has undergone important changes over the last century as a result of changing expectations of society, employers, and workers, as well as evolving federal and state regulations. The role of the occupational and environmental physician has expanded to enhancing the productivity of the worker with absence management and increased emphasis on the overall health, wellness, and safety of the worker – not just at the work site but also at home and in the community. The provision of occupational health care has also expanded from the industrial in‐plant clinic to university and community hospital‐based clinics, multi‐specialty group clinics, occupational medicine clinics, as well as private and government consultants. In many of these settings, the emphasis is on preventive interventions and policies rather than treatment. It is important that the practitioner be fully informed of all significant occupational and environmental health and safety activities, problems and concerns in order to provide necessary advice to assure a safe, healthy environment. These changes are reflected in the transition of terms from "industrial medicine" to "occupational medicine" and finally to "occupational and environmental health." There is increased recognition by organizations and regulatory agencies that occupational and environmental medicine (OEM) physicians and other licensed health care professionals have expertise in the development, implementation, evaluation and analysis of programs and policies that protect the worker.a The occupational and environmental physician often designs programs and manages health services directed toward defined populations, as well as engaging in clinical care that emphasizes the evaluation and treatment of individuals for both occupational and non‐occupational illness and injuries. Communities are increasingly in need of qualified medical professionals to advise them on risk assessment as it relates to the environment and to develop programs to protect the health of workers and other populations potentially exposed to environmental injury. The ability to interact with diverse stakeholders to prevent and manage injury and illness, and to promote health, wellness and productivity of working populations, gives occupational physicians a unique perspective and role in the medical community. The field of occupational and environmental health continues to be impacted by a variety of regulatory and public health agencies such as federal and state Occupational Safety and Health Administration, Nuclear Regulatory Commission, Environmental Protection Agency, Mine Safety and Health Administration, and Department of Transportation. Issues as diverse as bioterrorism, ergonomics, toxic exposures, indoor air quality, work place violence, wellness, productivity, and absence management all come under the realm of the occupational and environmental health physician. Additionally, as the United States' workforce is increasingly part of a global workforce, it is necessary for occupational and environmental (OEM) physicians to understand and foster the needs of the international worker and build ties with the occupational, safety and health care community internationally thus encouraging best practices. Appropriate training for participation in occupational and environmental health programs provides skill in clinical, environmental and occupational medicine, toxicology, epidemiology, biometry, and population health. In addition, practitioners understand how to enlist and collaborate with the colleagues from industrial hygiene, toxicology, occupational health nursing, safety engineering, industrial relations, health physics, ventilation engineering, mechanical engineering, biomechanics, law, public policy, and health education. The change in practice location in occupational and environmental medicine within the past decade has added another needed set of skills, those of data management. Computerization of medical information necessitates a sophisticated degree of "computer literacy" on the part of the occupational and environmental health professional. Knowledge of data management, including understanding all aspects of confidentially of medical records, is required. Lastly, occupational health professionals are advancing the field of health and productivity management (HPM). Integrated HPM is a component of occupational health, safety, loss and risk management, absence and disability management, health promotion, disease management, injury prevention, hazard control, and health care benefits management that includes evaluation of personal health care. The specific contents of any occupational and environmental health program are determined by the nature of the work organization, the products produced or services provided, the nature of the workforce, job tasks, activities and potential hazards and specific workplace or community activities. Occupational health programs must comply with all relevant local, state and federal laws and regulations. The following document identifies those services considered essential components of comprehensive occupational and environmental programs in meeting a standard of excellence. The components contained below are further defined and expanded in the Guide to a Healthy Workplace developed by the Corporate Health Achievement Award (CHAA) program of the American College of Occupational and Environmental Medicine (ACOEM). To learn more about each component and to have a clearer understanding of measuring these components, please refer to the CHAA Guide to a Healthy Workplace that can be found at www.chaa.org. LEADERSHIP AND MANAGEMENT Organization & Management Employers should assure that occupational medicine, industrial hygiene, safety and environmental health professionals have input into the decision making process related to health, safety and environmental issues. In all settings, this requires close alliance between OEM and OEH professionals, with all reporting to a level in the organization that will have a broad influence and global impact. OEM and OEH professionals should work collaboratively to identify, design and implement improvements to enhance health and productivity of the workforce as well as maintain a safe workplace. Health, safety and environmental programs should assist in interpreting and developing pertinent regulations and guidelines for business, labor organizations, government agencies and communities. Health, safety and environmental programs are most effective when organizational support and commitment to the health, productivity and safety of the workforce exists. Management must be willing to provide appropriate resources, encourage innovation and support positive change. OEM and OEH professionals must collaborate with management to meet the challenge of designing and disseminating cost effective health, safety, and wellness programs to an increasingly diverse and aging population, often at widely dispersed national and international sites. Programs should set uniform standards of care and encourage best practices throughout the organization, including internationally. Managers should understand the value of workplace occupational and environmental health and safety and must be able to manage change in a constructive and positive manner. Health Information Systems Effective health, safety and environmental programs use information systems to promote worker health and safety. Occupational health information systems (OHIS) can and should be used for multiple reasons, including: aggregate data collection and analysis, documentation of worker's medical surveillance, tracking medical appointments, delivery and documentation of training programs and health and wellness programs, communications between stakeholders, benefits education and tracking, as well as monitoring of chemical and other hazards. These systems help provide access to material safety data sheets (MSDS), Occupational Safety and Health Administration (OSHA) accident and injury logs, research data, updates to regulatory and governmental changes at the state and federal levels. These systems support statistical analysis, integrated case management and enable research of peer reviewed literature and delivery of continuing professional education. OHIS are needed to generate metrics used to identify problems, track compliance, manage programs and assure quality and effectiveness. These systems are also used to wisely allocate health resources. Health, safety and environmental programs must maintain occupational medical records on each worker, documenting the reasons for and results of all evaluations. Ideally these records should contain data sufficient to reproduce a chronology of the worker's medical history, workplace exposures, medical evaluations, illnesses, and injuries. As these systems provide powerful analytical tools, the organization must maintain appropriate control and meet all privacy requirements. Procedures must preserve confidentiality of all health information and medical records while allowing access to those with a bona fide need to know. If the records are computerized, their security must be assured and the information they contain kept confidential. OEH professionals must remain informed on regulatory issues affecting medical records, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Americans with Disabilities

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